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| Clopidogrel 'a reasonable option' for children with stroke |
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10 March 2006
Clopidogrel can been used without serious side effects in most children with arterial ischaemic stroke, Canadian researchers have reported, although they urge caution in patients with risk factors for cerebral bleeding.
The team from the Hospital for Sick Children in Toronto initiated clopidogrel treatment (1 mg/kg) in 17 stroke patients aged between 1.5 and 17 years who had suffered adverse reactions or recurrent stroke while on aspirin therapy. During a maximum 3 years of follow-up, no adverse reactions were seen in the eight patients treated with clopidogrel alone, Dr Teesta Soman and colleagues report in the journal Stroke.
However, two of the nine children who continued to receive aspirin in combination with clopidogrel suffered intracranial haemorrhage, resulting in withdrawal of both treatments. One of these patients had undergone recent surgery and the other had hypertension, which the investigators suspect may have contributed to the cerebral bleeding. In addition, both had marked cerebral atrophy, which has also been associated with increased risk of haemorrhage in older people. Furthermore, the young patients also exhibited intracranial vasculopathies that could have led to intracranial stenosis, dilated and fragile collateral vessels, and resultant bleeding.
"Thus, the combination of clopidogrel and aspirin should be used with caution in children with multiple risk factors for haemorrhage," the investigators conclude. They also note that none of the children suffered recurrent stroke during the study, but emphasise that the number of patients was too small and the study was not designed to address the effectiveness of clopidogrel.
Reference:
Stroke 2006; 37 (4): 1120-1122.
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